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Employer Benefits IQ
Plan Design

Copay

A fixed dollar amount a member pays for a covered service.

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Full Definition

A copay is a fixed dollar amount a health plan member pays for a specific covered service — typically a primary care visit, specialist visit, urgent care, or prescription drug. Copays are paid at the time of service and may or may not count toward the deductible depending on plan design. Copay-first plans (where copays apply before the deductible) are common in fully insured plans but less so in self-funded HDHP designs.